xRead - Nasal Obstruction (September 2024) Full Articles

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Orlandi et al.

TABLE II-1 Typical risks, side effects and adverse effects of common rhinosinusitis treatments* Treatment Possible side effects and adverse effects Nasal saline Nasal irritation, sneezing, cough

For high volume nasal irrigations: ear fullness, irrigation fluid transmission to middle ear Increased appetite, weight gain, fluid retention, gastritis, sleep disturbance, restlessness, anxiety, depression, aggressiveness, psychosis, adrenal suppression, cataracts, glaucoma, hair/skin changes, easy bruising, acne, delayed wound healing, muscle weakness, change in body fat distribution, immunosuppression, hypertension, hyperglycemia/diabetes, osteopenia, osteoporosis, avascular necrosis of the hip, kidney stones Discomfort/burning, epistaxis, dryness, crusting, foul taste, headache, sore throat Gastrointestinal upset, bloating, stomach cramping, nausea, vomiting, diarrhea, fungal infections, drug-drug interactions, photosensitivity, bone/teeth staining, allergic reaction, anaphylaxis, C. difficile colitis, hepatic impairment, renal impairment, antibiotic resistance, ototoxicity For macrolides: cardiotoxicity Irritability, anxiety, restlessness, sleep disturbance, hypertension, tachycardia, heart palpitations, drug-drug interactions, tremors In young children: tachycardia, seizures, loss of consciousness, death Discomfort/burning, dependency, dryness, increased congestion, rhinitis medicamentosa, hypertension, anxiety, tremors Drowsiness, headache, dry mucous membranes, restlessness, anxiety, insomnia, tachyphylaxis, urinary retention, Discomfort/burning, drowsiness, dizziness, epistaxis, dryness, crusting, foul taste, headache, sore throat, sneezing, nausea Behavior/mood alterations, agitation, depression, irritability, hallucinations, tremor, suicidal thoughts and behavior For zileuton: hepatotoxicity Bleeding, infection, scarring, septal perforation, lacrimal system injury, hyposmia/anosmia, vision changes or blindness, orbital injury, cerebrospinal fluid leak, intracranial injury, major vascular injury Table XII-26 contains an in-depth list of ESS complications.

Systemic/oral corticosteroids

Nasal corticosteroids Systemic/oral antibiotics

Oral decongestants

Nasal decongestants

Oral antihistamines

Nasal antihistamines

Leukotriene antagonists

Nasal/sinus surgery

*May not include all possible risks of listed interventions

treatment of RS. One area that will stand out, however, is this document’s continued division of CRS into CRSwNP and CRSsNP. Our understanding of CRS clearly shows that division into these 2 phenotypes is artificially simplistic and that multiple underlying endotypes end up manifest ing as these downstream groupings. Despite our collective rapid advancements in the mechanistic aspects of CRS, we have not arrived at the point where we are able to clas sify CRS into universally agreed upon, well-defined endo types. Moreover, nearly all the evidence published to date relies upon the CRSw/sNP paradigm, rather than endotyp ing. Clearly, we must move beyond this overly simplistic paradigm in order to provide our patients with more pre cise and personalized treatments. The authors collectively call upon themselves and the entire rhinologic commu nity to quickly produce the necessary evidence, agreement, and then prospective research to move past the CRSw/sNP paradigm.

Any consensus statement on so wide ranging a topic as RS will have limitations and this one is no different. The recommendations are only as good as the evidence that underlies them, which again is found to be variable and, in some areas, sorely lacking. Thus, the recommen dations offered in this document should be interpreted in the context of the robustness of the evidence upon which they are based and the populations of patients studied to produce the evidence. The practice of evidence-based medicine (EBM) requires the clinician to have the best available evidence, and then combine that with individual expertise and the patient’s condition, values, and expecta tions (Figure III-2). 137 This ICAR-RS-2021 document pro vides only the best available evidence. It may not, there fore, be seen as a “cookbook” for providing care for the RS patient. While the recommendations in this document are based on the best available evidence, they do not define